Oxycontin reformulation

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epidural man

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I don't even do chronic narcs and I've been hearing a lot from pts (who get it from pcp's) how the new version "doesn't work". They have also complained about the pill coming out whole in the toilet which I recall some pts complaining about before too (' the pill did not dissolve') but it now occuring more so?
 
first of all... how does somebody know the pill came out whole??? who checks out their stool on a regular basis looking for whether a pill was absorbed/digested or not???
 
You mean you don't have your opioid patients routinely straining their feces? It can be an excellent psychological diversion from the pain and can create an entirely new psychopathology.....
 
first of all... how does somebody know the pill came out whole??? who checks out their stool on a regular basis looking for whether a pill was absorbed/digested or not???

those of us who have ever had corn might be able to answer that question....
 
okay... ssdoc33.... you eat one kernel of corn... just one (since that would be the equivalent of one fat oxycontin)... are you going to

1) check your stool for it?
2) notice the ONE kernel of corn in your stool?

my simple answer: just tell the patient to chew the oxycontin and they won't see it in their stool anymore..

those patients that I do believe are the ones who have ileostomies --- they tend to see all kinds of things in those bags.
 
I am so glad that I stopped prescribing oxycontin once I got into practice. This eliminated many suspect patients. Many people who are on this drug are very unhappy with this new formulation. Some of whom are asking their physician to switch them to another med. Even with the new formulation, I have no intent in prescribing oxycontin, especially in a high drug abuse and diversion area that I work at
 
I just don't get it. Is there some kool-aid drinking lecturer out there spouting about the woes of Oxycontin? It is no different than Percocet. You all must be believing in tooth fairy science or media hype. It is no more addictive than any other opiate. It is the patient (or scammer) and not the drug. The guy asking for Oxycontin because he moved from out of state and just took his last pill from his doc who went to jail will abuse anything you give him. But for blanket statements regarding "will not prescribe" is stupid. If you are an MD or DO, you are a scientist first. Put out or get out your science based medicine before barking.

If you say I never prescribe Demerol because of its active and toxic metabolites and seizure potential, or I never prescribe methadone because of its rare but real ability to prolong QT intervals and wildcard half-life, then that is science based. If you say I never prescribe Dilaudid because it is too addictive and grandma with a fracture will get hooked- then you are an idiot.

Again, my 2 cents. But if no one calls it like they see it, then just a big rock on the lot of us. Prove me wrong so I can learn something.
 
I just don't get it. Is there some kool-aid drinking lecturer out there spouting about the woes of Oxycontin? It is no different than Percocet. You all must be believing in tooth fairy science or media hype. It is no more addictive than any other opiate. It is the patient (or scammer) and not the drug. The guy asking for Oxycontin because he moved from out of state and just took his last pill from his doc who went to jail will abuse anything you give him. But for blanket statements regarding "will not prescribe" is stupid. If you are an MD or DO, you are a scientist first. Put out or get out your science based medicine before barking.

If you say I never prescribe Demerol because of its active and toxic metabolites and seizure potential, or I never prescribe methadone because of its rare but real ability to prolong QT intervals and wildcard half-life, then that is science based. If you say I never prescribe Dilaudid because it is too addictive and grandma with a fracture will get hooked- then you are an idiot.

Again, my 2 cents. But if no one calls it like they see it, then just a big rock on the lot of us. Prove me wrong so I can learn something.

In some communities, you do better avoiding certain opioids that are the favorites of the community. In some places, Norco is the drug du jour. In others, they won't take anything but Vicodin. In still others, it's Locet and Lortab. I suspect it has much to do with the prescribing habits of local PCPs, who in turn were influenced 20 years ago by whichever product had the hottest reps and/or who brought them the best gifts.

There are communities in America where an Rx for Oxycontin will likely get you labeled by the pharmacists as a drug dealer, even if it's for cancer. Some pharmacies won't carry it any longer, out of fear for their safety.

On the flip side, I once had a pharmacist call me and ask me to write a new Rx for Oxycontin for a patient - he filled it early w/o an Rx and needed the Rx to "cover" himself. I don't know the outcome of the DEA and state pharmacy board investigations, but I let them take it from there.

You are correct that it is not the drug, it's the people. But name-recognition goes pretty far. In my old job, it was amazing how many people came to me on OxyContin, and how few on MS Contin. Same company, same basic drug delivery. Both Schedule II opioid agonsists, with theoretically the same risk of abuse. But one was so far more abused than the other. I believe it was all due to the name.
 
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i agree that blanket avoidance of one drug because of media hype is non-scientific...

a better approach is to avoid narcotic prescribing as best as you can, because that is actually based on hard science.... narcotics are bad for your health (and recent pseudo-study of 13,000 patients shows there is a correlation with higher fracture risk and higher cardiac deaths)
 
I have heard from multiple patients in my area that the new formulation does not work as efficaciously as the older one.
 
i just had patient flip out on my 2 weeks ago... they were taken off oxycontin because it was non-formulary, and they didn't have money to pay cash for oxycontin... they were now on morphine ER (at double the equi-analgesic dose), stating it didn't work and wanted to back on oxycontin --- mysteriously, no morphine in urine....hmmmm...

i agree - brand name recognition is fantastic on the streets...

it just goes to show that all those advertising dollars were well spent...
 
The pharm rep told me that the pill appears to have been excreted whole but in fact the medication has been released. It would be interesting to pluck one out and see what is left of it.
 
first of all... how does somebody know the pill came out whole??? who checks out their stool on a regular basis looking for whether a pill was absorbed/digested or not???

For many chronic pain patients on opiates, this may be an exaggeration, for others will loose stools (largely due to polyethelyne glycol, Amitiza, ducosate sodium, lactulose & other meds to treat constipation, they can clearly see it in the toilet without further investigation.)

I saw one pt. bring one in a lunch bag into the office just to show us she wasn't kidding.:laugh: Seriously though, the pt was clearly having signs of W/D, as have others on the same medication.

Digestive problems are inherent in opioid treatment, and yes, the complaints about the new OxyContin seem to be universal here. I've yet to see a pt. doing well on the new "OP" formula. The clinical doc here has switched every patient he has that was on it to other meds.
 
For many chronic pain patients on opiates, this may be an exaggeration, for others will loose stools (largely due to polyethelyne glycol, Amitiza, ducosate sodium, lactulose & other meds to treat constipation, they can clearly see it in the toilet without further investigation.)

I saw one pt. bring one in a lunch bag into the office just to show us she wasn't kidding.:laugh: Seriously though, the pt was clearly having signs of W/D, as have others on the same medication.

Digestive problems are inherent in opioid treatment, and yes, the complaints about the new OxyContin seem to be universal here. I've yet to see a pt. doing well on the new "OP" formula. The clinical doc here has switched every patient he has that was on it to other meds.

Yep. I used to get patients claiming the same and had one bring me the pill from the toilet to show me. Rep said the med had been delivered and it was just the "matrix" in the stool.

OxyContin as a name is powerful. The brand-name recognition make a huge difference to some pain patients and most addicts.
 
I just don't get it. Is there some kool-aid drinking lecturer out there spouting about the woes of Oxycontin? It is no different than Percocet. You all must be believing in tooth fairy science or media hype. It is no more addictive than any other opiate. It is the patient (or scammer) and not the drug. The guy asking for Oxycontin because he moved from out of state and just took his last pill from his doc who went to jail will abuse anything you give him. But for blanket statements regarding "will not prescribe" is stupid. If you are an MD or DO, you are a scientist first. Put out or get out your science based medicine before barking.

If you say I never prescribe Demerol because of its active and toxic metabolites and seizure potential, or I never prescribe methadone because of its rare but real ability to prolong QT intervals and wildcard half-life, then that is science based. If you say I never prescribe Dilaudid because it is too addictive and grandma with a fracture will get hooked- then you are an idiot.

Again, my 2 cents. But if no one calls it like they see it, then just a big rock on the lot of us. Prove me wrong so I can learn something.

i agree with you on this.
But the problem is that the people looking to get high think that they have to get oxy. It's all about brand recognition. Is the iphone better than android evo? Is Louis vitton really a better made purse than coach? Every girl out there wants a Louis because that is the brand they think is the one to get
 
i agree with you on this.
But the problem is that the people looking to get high think that they have to get oxy. It's all about brand recognition. Is the iphone better than android evo? Is Louis vitton really a better made purse than coach? Every girl out there wants a Louis because that is the brand they think is the one to get

But to say you cannot have Louis Vuitton, only a Target bag, because of you (the shopper, or for us the patient)- makes no sense.

It's not the drug, it's the patient. If someone is at risk, our job is to determine how much risk is involved for them and make the decision to prescribe or not prescribe. If they are not at risk or low risk, and opiates are part of care- then I will prescribe whatever I think, through trial and error, will work best.

I turn away 1/3 of new patients requesting unimodal care with opiates because I do not provide unimodal care with opiates. 2/3 of them agree to try and make their life better via PT, TENS, procedures, DLS, counseling, etc. For folks who are blowing smoke up my butt, I make ongoing opiates contingent on continued progress with therapy/counseling, weight loss, etc.

I have many little old ladies on Dilaudid for their fractures. I have plenty of 70+ folks on Oxycontin 40mg bid/tid. I have 2 patients on methadone. With separate informed consent for methadone.

So many easier targets to score from besides me.
 
i agree with you on this.
But the problem is that the people looking to get high think that they have to get oxy. It's all about brand recognition. Is the iphone better than android evo? Is Louis vitton really a better made purse than coach? Every girl out there wants a Louis because that is the brand they think is the one to get

the evo is bettrer
 
Remember this wonderful thread?
http://forums.studentdoctor.net/showthread.php?t=405705&highlight=oxycontin

Anyway, does anyone know if the new formulated oxycontin has some of its dose dumped - or immediately released, or is it finally a true sustained release product?

It is a "true sustained release product".

The carrier for the drug is a particular hydrophilic PolyEthylene Oxide (PEO) polymer (brand name PolyOx&#8482😉 with a molecular weight in the neighborhood of around six million (compared with the API, oxycodone, which is a little over 400). The polymer chain is so long that the dispersed API particles are literally trapped¹ no matter how finely the abuser grinds the tablet to a powder. Dissolving the polymer carrier does not in and of itself release the API, which remains trapped. Dissolving the carrier in water, however, activates the slow release mechanism. After hydration, the API is freed to be able to diffuse ("worm it's way") through the maze of hydrated PEO that constitutes what prospective abusers call "the gel". This begins early on in the digestive process. The "gel" then mixes with chyme, and slow API release takes place throughout it's trek through the gut. This is distinctively different from the old OxyContin, which released it's API as a result of gastric juices slowly displacing the contents of a rigid hydrophobic polymer matrix. Whereas with the old formula, you had a tablet releasing it's contents slowly as it proceeded through the gut, with the new formula, the PEO has completely dissolved and mixed with much of the gut's contents², and release of the trapped API slowly takes place throughout those contents as it all moves through the gut.

Despite the new drug formulation being a "true sustained release product", with enough effort, any anti abuse measure could be at least partially thwarted. Scanning relevant web sites, however, reveals that most abusers are finding the new formula to be "too difficult a nut to crack", and rather than bothering to try, they are simply abusing other drugs instead, such as heroin.

Although Purdue is being careful to avoid calling the new formula abuse proof, I think that the behavior of the abusers "speaks volumes".

Notes:
¹ Some have likened this PolyOx™ PEO molecule to a strip of wrapping paper 100 inches long and a microscopic sized particle of oxycodone to a ½" marble to illustrate by analogy how collections of PEO molecules can be made to entrap oxycodone.

²An understanding of this process could conceivably lend credence to claims some patients have made of perceiving that other drugs they take (zolpidem, for example) have been taking "longer to kick in" and "longer to wear off" since they started receiving reformulated OxyContin.
 
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Attached a little info on the new stuff.
 

Attachments

  • New OC.jpg
    New OC.jpg
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It's important to understand the political backdrop when discussing something like this....The FDA and DEA are all over the medical community re: opiate abuse. Heck, even new potent meds (such as Onsolis) must have a pre-approved risk mgt plan (REMS) while their direct competitors (Actiq, Fentora, & etc.) do not. Huge disconnect IMHO.

Re: the new OC, there was a big rush to roll this out, and if you look at the testing, it wasn't very robust. I certainly wouldn't take it.

Regardless, many of the patients have all been saying the same thing....It doesn't work nearly as well, and takes longer to work period. IMHO, something is going on....Looks like a duck, walks like a duck & etc. Sure, there are abusers out there who do a little Googling and jump on the bandwagon, in order to get their DOC, but I'm talking about the little old ladies, or those patients one would never suspect manipulating the med. Those are the ones who concern me greatly, and they are obviously suffering a great deal.


I'm not a Dr, but I'm not convinced science has gotten to the point where certain formulations can pass through undisturbed (if not abused) while others cannot. Way too much individual variation in people (metabolisms & etc). And as a general rule, as I've gotten older and more experienced in pharmacy, there's less I trust about "new claims" in medicine. Just my .02.

IP
 
I
Re: the new OC, there was a big rush to roll this out, and if you look at the testing, it wasn't very robust. I certainly wouldn't take it.
IP

Ok. I looked at the testing. The reformulated oxycontin trials at clinicaltrials.gov

The trials were all open label. The subjects were all opiate naive. They were given one tablet apiece, and then had blood drawn to check serum levels over a 72 hour period.

After a washout period of at least six days, those who had been given a tablet of the old formula received a tablet of the new formula, and vice versa. Serum levels were again measured for 72 hours.

After 72 hours, serum levels were then extrapolated out to infinity.

In three of the eight trials subjects were given 80 mg tablets. Some of those (again, opiate naive individuals) given 80 mg tablets reportedly experienced no adverse effects. (Not even somnolence. In most of the studies, between 2.5% and 13% of subjects experienced somnolence.) Although there is no mention of it, one wonders if study subjects were being administered an opiate antagonist.

I could go on, but reading these reports feels like a visit to the twilight zone. At the very least, in my case, it brought on vertigo.

In my opinion, these trials were insufficient to demonstrate biocompatibility with the original oxycontin formula. Especially, as a number of the manufacturer's own dosage and administration rules/guidelines were violated.
 
first of all... how does somebody know the pill came out whole??? who checks out their stool on a regular basis looking for whether a pill was absorbed/digested or not???

More people than you might think. For example, IBD patients who report apparently undissolved Asacol, Lialda, or Salofalk shells floating in their liquid stools. The patient leaflets for those drugs instruct them to notify their doctors if they see "undissolved tablets" in their stool. Those who bother to read the leaflet are probably those who also bother to look.

Just as a point of trivia, while visiting the subject of stools, the hydrophilic properties of the polyethylene oxide excipient that makes up the bulk of the new oxycontin tablets could impart a slight benefit to some constipated patients. (Curiously, some patients who read the package insert complain that the new formula contains a laxative (as if that's a bad thing for opiate users) because they see polyethylene glycol 400 in the ingredients, and make a connection between that and the laxative Miralax (which is PEG 3350, not PEG-400), not being aware that PEG-400's big cousin PEO-6,000,000 is much more hydrophilic, or that the old oxycontin formula also contained PEG-400).
 
I promise I have no plans to try... I am referring to the video posted earlier of the oxycontin abuse in Florida, featuring a young man who smoked his pills.
 
So back to an earlier thread, can you smoke the new stuff?

Good question. Although I would suspect Purdue took that into account, there's nothing scientific about suspicions. Being retired, however, I have plenty of free time that I can use to try to find out. I'll let you know if I learn anything.
 
So back to an earlier thread, can you smoke the new stuff?

It looks like the answer is "no".

I Googled for "smoking reformulated oxycontin", and found many hits. Unfortunately, many of them were for for smoking the old oxycontin formula (and yes, people were doing that!) and for smoking tobacco, so I had to wade through a lot of extraneous sites.

When I did encounter relevant forum posts, they went pretty much like this:

"with these new OP larger pills. i notice most of the oxy heads that smoke. started freaking out. complaining how you can't smoke them. they catch fire. and are way to harsh to smoke. i even heard of some people crying how they are no longer smokable (HAHA)"

"I do think this could cause some bad things to happen to other drugs. in my town dilaudid has become more popular and more sooo many people are shooting them now but they are alwasy ten bucks for an 8mg. maybe sinse people cannot smoke oxy anymore. Dillies will become even more popular prices for them might start to rise up."
 
It looks like the answer is "no".

I Googled for "smoking reformulated oxycontin", and found many hits. Unfortunately, many of them were for for smoking the old oxycontin formula (and yes, people were doing that!) and for smoking tobacco, so I had to wade through a lot of extraneous sites.

When I did encounter relevant forum posts, they went pretty much like this:

"with these new OP larger pills. i notice most of the oxy heads that smoke. started freaking out. complaining how you can't smoke them. they catch fire. and are way to harsh to smoke. i even heard of some people crying how they are no longer smokable (HAHA)"

"I do think this could cause some bad things to happen to other drugs. in my town dilaudid has become more popular and more sooo many people are shooting them now but they are alwasy ten bucks for an 8mg. maybe sinse people cannot smoke oxy anymore. Dillies will become even more popular prices for them might start to rise up."


Just so I got this right:
"Oxys" = Oxycontin
"Dillies" = Dilaudid
"Xanies" or "bars" = Xanax
"Percs" = Percocet
"Vics" = Vicodin

there must be more. Chime in!
 
Just so I got this right:
"Oxys" = Oxycontin
"Dillies" = Dilaudid
"Xanies" or "bars" = Xanax
"Percs" = Percocet
"Vics" = Vicodin

there must be more. Chime in!

"Roxies" in some places of the country, because Roxicodone was marketed better.
 
"Roxies" in some places of the country, because Roxicodone was marketed better.

"my ortho gave me dillata because i tore my rotor cuff......"
 
we are starting to see more and more ppl "requesting" opana ER in clinic, ppl that are a bit suspect.. its starting to sound like opana is headed in the direction of oxys.. what do u guys think?
 
we are starting to see more and more ppl "requesting" opana ER in clinic, ppl that are a bit suspect.. its starting to sound like opana is headed in the direction of oxys.. what do u guys think?

If those people are in your clinic, you need better screening tools before they get into an exam room.

It's the addict, not the drug.
 
The recent news articles reporting that 90% of Oxycontin doses prescribed nationwide were dispensed in the state of Florida may help put the following post, found on a pharmacy web site, into perspective. Reading between the lines (admittedly, sometimes a dangerous thing to do), there may be something even bigger in the works than the major (a big deal was made over one of the closed practices that had been clearing $150K/day) drug mill arrests in the state of Florida over the last several weeks.

From "CafePharma.com":

Exactly? What that Purdue reps are the lowest form of scum in pharma. You sold/sell a drug where 60-75% goes on the street. It is a fact. Just keep convincing yourselves of "all the cancer patients" you are helping. It's a joke. That is why your co gets sued daily. Little drug dealers running around with a hotspot in Florida. Florida reps should stare in mirror at least 10 minutes a day and realize they are killing families all over the state. Must feel good going to work being a "pharma rep". Try Teva, they will laugh in your face you brainwashed drug pushers

Genus Spliced, people!!!!

There are 49 other states in which there weren't doctors making $150K a day off this drug.
Many in which Oxycontin had to be prescribed on triplicate forms that physicians had to pay a dollar apiece to their states for, such that said states had a copy of every single prescription that was written. It was illegal in many states to replace triplicate prescriptions that were "lost" or "stolen" after delivery to the patient. Even if they really were lost or stolen, the best physicians could do for their patients in those circumstances was to help ease the patient's withdrawal symtoms.

Florida's getting so horribly infested was not just due to some lucky Purdue reps. Florida's lawmakers have to take a large part of the responsibility. Perhaps all these people talking about filing a class action or or mass tort action against Purdue might instead find it is more productive to retarget their sights squarely at Florida's elected representatives.

One of the tricks that Purdue's lawyers use involves the use of amicus briefs designed to get the judge to side with them on the idea that their state should not become known as a litigation magnet state which takes the brunt and costs of actions, the majority of the members of which are from from 49 other states, and most not from the state in which the action is taking place. The problem with that argument is that it can be applied in any state in which a case could eventually reach fruition. It's a clever trick that stops the lawsuits right in their tracks. And the judges either don't, or don't want to, see the consequences.

Now, if a state, or it's representatives, become the target of the suit, rather than just it's venue, it becomes a whole 'nother ball of wax.

As a matter of pure speculation (and, of course, there are any number of other, totally different, ways in which this could be handled), it might be possible to show that certain lawmakers who resisted the idea of using triplicate forms in Florida were conspirators in a massive fraud on the American people, involving the cultivation of drug addicts for profit, with certain conspirators acting as lobbyists aiding and abetting a ruse that resulted in the replacement of a time tested drug with a poorly designed drug, with consequences that not only could be reasonably anticipated, but which were in fact explicitly expressed as worrisome concerns in the minutes of the FDA panel that met to vote on the oxycontin reformulation . It might be speculated, or otherwise considered, that agents of Purdue Pharma LP, acting as co-conspirators, encouraged some FDA panelists to misinterpret data, described by some sympathetic parties as "damning, if only they had been correctly interpreted", from eight open label phase one studies (in which only healthy opiate naive subjects subjects were administered huge oxycodone doses while putatively having also been administered an opioid antagonist) that were used as a major portion of the basis of an FDA decision that became a critical fulcrum in the matter, illnesses on a massive scale.

It should be noted that while some are laughing at the situation in Florida, there are others who take a vital interest in matters that were precipitated in large part by that situation, and who are dealing only in facts, not in speculation.​

It seems to me that "resulting in illnesses on a massive scale" is itself speculation. I haven't seen any proof that the reformulated drug causes any lasting harm, although the pre-approval testing methodology was horrid, and the data obtained failed to prove the opposite, that the new drug would be either safe or effective.
 
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